Opioids and Pain Treatment

Dentists have a responsibility to provide safe and effective pain relief for their patients while at the same time limiting the prescription of opioids to an appropriate amount. Dentists play a vital role in preventing the abuse and misuse of prescription medications.

MDS Position on Opioids

The MDS is committed to helping its members provide safe and effective pain control for their patients by utilizing evidence-based prescribing practices applying non-pharmacological strategies as well as non-opioid and opioid pain medications as appropriate.

As part of Governor Charlie Baker’s Working Group on Dental Education on Prescription Drug Misuse, Massachusetts dentists were the first in the nation to partner with the Commonwealth’s three dental schools to announce a set of dental education core competencies for the prevention and management of prescription drug misuse. Massachusetts dentists also worked with policymakers to enact landmark legislation limiting opioid prescriptions to a seven-day supply for minors and first-time adult prescriptions. This legislation, passed in 2016, also included mandatory continuing education and prescription monitoring requirements.

The MDS supports:

Mandatory continuing education in prescribing opioids and other controlled substances

Statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the U.S. Centers for Disease Control and Prevention evidence-based guidelines

Dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse

The Opioid Epidemic

Most opioids prescribed to patients in the United States are written by physicians and other medical professionals for management of chronic (long-term) pain. Dentists with an appropriate license may also prescribe opioids, typically for management of acute (short-term) pain, such as severe tooth decay, tooth extraction, or root canals.

According to the U.S. Department of Health and Human Services, health care providers began to prescribe opioid pain relievers at greater rates in the late 1990s, following reassurances from pharmaceutical companies that patients would not become addicted. Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.

Opioids and Oral Health: Get the Facts

In 2012, dentists ranked fourth among all medical specialties in opioid prescribing rates, and they were the leading prescribers of opioids for U.S. teens. Nationwide, the largest increase in oral health opioid prescriptions from 2010-2015 was among patients aged 11 to 18. This is a common age range for painful oral surgery procedures, such as wisdom teeth removal.

While each patient is unique, many dentists are now considering non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen as the first-line therapy for pain management. Across all age groups, dentists in the United States wrote nearly half a million fewer opioid prescriptions over a five-year period, from 18.5 million in 2012 to 18.1 million in 2017.

Massachusetts dentists are committed to being leaders in curbing opioid misuse by following responsible prescribing practices and utilizing non-opioid alternatives where appropriate. According to the Massachusetts Prescription Management Program, dentists issued 46% fewer opioid prescriptions in the first quarter of 2018 than in 2015, and they prescribed the medication in much smaller quantities.

What to Ask Your Dentist Before Taking Opioids

The oral health community is committed to protecting patients and doing its part to address the epidemic of opioid abuse. Helping patients have thoughtful conversations with their dentist is a critical step in the process.

Before you agree to an opioid prescription for yourself or your child, get the facts and ask questions:

Why do I need this medication–is it right for me?

Are there non-opioid alternatives that could help with pain while I recover?

What are the potential side effects from this medication?

What if my family or I have a history of addiction with tobacco, alcohol, or drugs?

Could this treatment interact with my other medications?

If I need opioids, how many opioids are absolutely necessary? Can we start with a smaller prescription and then fill a second only if necessary?

What should I do with unused opioid medicine?

Safe Administration and Storage of Opioid Medication

If you or your child has been prescribed an opioid medication, be sure to follow these safety guidelines:

DON’T allow children or teens to administer their own medication.

DON’T take medicine in front of children who often mimic adults.

DO monitor how many pills are in each of your prescription bottles.

DO secure your prescriptions in the same way you would other valuables.

DO keep medicine out of the reach of children.

DO store medicine in its original container–the label on the bottle provides important information about the medicine.

DON’T leave medicine in places that are easily accessible to children or pets.

Safe Disposal of Opioid Medication

Do your part to safely dispose of any unused opioid medications:

Discard expired or unused medications as soon as you are done with them.

Check prescription dropbox locations to see if there is a permanent waste medication collection site in your town or city, or check for medication “takeback” programs with your local police or fire department, or authorized collection site, such as a pharmacy.

If you cannot get to a dropbox or collection site, hide medication containers in the trash. DO NOT put them in your recycle bin!

Keep medications in their original containers. Leave drug names visible to help identify the contents if they are accidentally swallowed. Cross out other personal information.

You know that soda isn’t a healthy way to quench your thirst, but sometimes you just want a little fizzy burst, so you reach for a sparkling water or seltzer. But do those little bubbles spell trouble for your teeth?